{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T08:06:06Z","timestamp":1789632366456,"version":"build-2803163510"},"reference-count":20,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Cardiovasc Disord"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Oral hygiene is a key component of health. Practices for oral hygiene include brushing teeth with toothpaste, flossing, and mouth washing. It has been reported that 36% of United States adults use mouthwash daily. However, antibacterial mouthwashes kill oral nitrate-reducing bacteria, thus impairing nitric oxide production. Nitric oxide is a key molecule in vasodilation and blood pressure regulation, often acting as a mediator, so there is a potential for antibacterial mouthwashes to cause elevated blood pressure. Therefore, we conducted a scoping review to address the question: Does antibacterial mouthwash use significantly increase blood pressure in humans?<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A scoping review was conducted utilizing the databases PubMed and Scopus. Our search terms included \u201cmouthwash,\u201d \u201cchlorhexidine,\u201d \u201cantibacterial,\u201d \u201csalivary nitrite,\u201d \u201cnitrate,\u201d and MeSH terms like \u201cblood pressure\u201d and \u201chypertension.\u201d Inclusion criteria required primary research articles since 2014 that analyzed changes in blood pressure in human adults after using antibacterial mouthwash. Studies with pediatric participants, animal studies, reviews, or studies that did not measure blood pressure changes were excluded. 51 studies were retrieved from the search, and after independent screening by two reviewers, nine studies were included in the scoping review. Reviewers extracted data on study methodology, sample size, participant characteristics, type of mouthwash, mouthwash regimen, and study results. Reviewers also appraised study quality using a modified Downs and Black assessment checklist.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Nine studies were included: four randomized crossover trials, three nonrandomized crossover trials, one active-controlled trial, and one observational study. The studies were of good quality (mean modified Downs and Black score was 21.9\u2009\u00b1\u20092.9 out of 28 points). Five studies found significant blood pressure elevations after mouthwash usage, while four studies found no significant relationship.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Heterogeneity in intervention lengths, mouthwash composition, participant characteristics, and blood-pressure assessment schedules, in addition to methodological weaknesses (such as inadequate washout periods and lack of randomization) in some studies make the pooled evidence inconclusive. Consequently, no firm conclusions can be drawn regarding the effect of antibacterial mouthwash on blood pressure at this time. Future research should utilize larger, randomized trials with standard washout periods and long-term monitoring to further clarify the relationship between antibacterial mouthwash usage and blood pressure.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12872-026-06572-4","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T06:05:11Z","timestamp":1789538711000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The effect of antibacterial mouthwash on blood pressure in humans: a scoping review"],"prefix":"10.1186","volume":"26","author":[{"given":"Bhavik","family":"Singh","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Parker","family":"North","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zo\u00eb M.","family":"Rushetsky","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard C.","family":"Brito","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr.","given":"Francis E.","family":"Jenney","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,16]]},"reference":[{"issue":"Suppl 3","key":"6572_CR1","doi-asserted-by":"publisher","first-page":"e60","DOI":"10.1097\/01.hjh.0000939356.11140.92","volume":"41","author":"K Aizawa","year":"2023","unstructured":"Aizawa K, Thompson C, Hughes AD, Parker KH, Shore AC, Vanhatalo A, et al. Effects of 2-week dietary nitrate supplementation and antibacterial mouthwash treatment on reservoir-excess pressure parameters in healthy older adults. J Hypertens. 2023;41(Suppl 3):e60.","journal-title":"J Hypertens"},{"key":"6572_CR2","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1016\/j.freeradbiomed.2019.05.010","volume":"138","author":"A Ashworth","year":"2019","unstructured":"Ashworth A, Clarke C, Farnham G, Liddle L, Burleigh M, Rodiles A, et al. Dietary intake of inorganic nitrate in vegetarians and omnivores and its impact on blood pressure, resting metabolic rate and the oral microbiome. Free Radic Biol Med. 2019;138:63\u201372.","journal-title":"Free Radic Biol Med"},{"key":"6572_CR3","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1016\/j.niox.2019.07.002","volume":"91","author":"AM Babateen","year":"2019","unstructured":"Babateen AM, Shannon OM, Mathers JC, Siervo M. Validity and reliability of test strips for the measurement of salivary nitrite concentration with and without the use of mouthwash in healthy adults. Nitric Oxide. 2019;91:15\u201322.","journal-title":"Nitric Oxide"},{"key":"6572_CR4","doi-asserted-by":"publisher","DOI":"10.1016\/j.jksus.2024.103183","author":"HA Bagabir","year":"2024","unstructured":"Bagabir HA, Bagabir R, Johargy AK, Faidah H, Babalghith AO, Bantun F, et al. A meta-analysis of cohort and pilot studies indicates association of mouthwash use and risk of hypertension in adults. J King Saud Univ Sci. 2024. https:\/\/doi.org\/10.1016\/j.jksus.2024.103183.","journal-title":"J King Saud Univ Sci"},{"issue":"1","key":"6572_CR5","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1038\/s41405-025-00294-z","volume":"11","author":"MAH Ballouk","year":"2025","unstructured":"Ballouk MAH, Altinawi M, Al-Kafri A, Zeitounlouian TS, Fudalej PS. Propolis mouthwashes efficacy in managing gingivitis and periodontitis: a systematic review of the latest findings. BDJ Open. 2025;11(1):5.","journal-title":"BDJ Open"},{"issue":"1","key":"6572_CR6","doi-asserted-by":"publisher","first-page":"5254","DOI":"10.1038\/s41598-020-61912-4","volume":"10","author":"R Bescos","year":"2020","unstructured":"Bescos R, Ashworth A, Cutler C, Brookes ZL, Belfield L, Rodiles A, et al. Effects of chlorhexidine mouthwash on the oral microbiome. Sci Rep. 2020;10(1):5254.","journal-title":"Sci Rep"},{"issue":"1","key":"6572_CR7","doi-asserted-by":"publisher","first-page":"2439636","DOI":"10.1080\/20002297.2024.2439636","volume":"17","author":"R Bescos","year":"2025","unstructured":"Bescos R, du Toit L, Redondo-Rio A, Warburton PJ, Nicholas TL, Kiernan M, et al. The comparative effect of propolis and chlorhexidine mouthwash on oral nitrite-producing bacteria and blood pressure regulation. J Oral Microbiol. 2025;17(1):2439636.","journal-title":"J Oral Microbiol"},{"issue":"5","key":"6572_CR8","doi-asserted-by":"publisher","first-page":"572","DOI":"10.1093\/ajh\/hpu192","volume":"28","author":"CP Bondonno","year":"2015","unstructured":"Bondonno CP, Liu AH, Croft KD, Considine MJ, Puddey IB, Woodman RJ, et al. Antibacterial mouthwash blunts oral nitrate reduction and increases blood pressure in treated hypertensive men and women. Am J Hypertens. 2015;28(5):572\u20135.","journal-title":"Am J Hypertens"},{"key":"6572_CR9","doi-asserted-by":"publisher","unstructured":"Bowles EF, Burleigh M, Mira A, Breda V, Weitzberg E, Rosier BT. Nitrate: \u201cthe source makes the poison. Crit Rev Food Sci Nutr. 2025:1\u201327. https:\/\/doi.org\/10.1080\/10408398.2024.2395488.","DOI":"10.1080\/10408398.2024.2395488"},{"issue":"6","key":"6572_CR10","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1136\/jech.52.6.377","volume":"52","author":"SH Downs","year":"1998","unstructured":"Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health. 1998;52(6):377\u201384.","journal-title":"J Epidemiol Community Health"},{"issue":"2","key":"6572_CR11","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1159\/000529162","volume":"57","author":"J Feng","year":"2023","unstructured":"Feng J, Liu J, Jiang M, Chen Q, Zhang Y, Yang M, et al. The role of oral nitrate-reducing bacteria in the prevention of caries: a review related to caries and nitrate metabolism. Caries Res. 2023;57(2):119\u201332.","journal-title":"Caries Res"},{"issue":"1","key":"6572_CR12","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3945\/ajcn.2008.27131","volume":"90","author":"NG Hord","year":"2009","unstructured":"Hord NG, Tang Y, Bryan NS. Food sources of nitrates and nitrites: the physiologic context for potential health benefits. Am J Clin Nutr. 2009;90(1):1\u201310. https:\/\/doi.org\/10.3945\/ajcn.2008.27131.","journal-title":"Am J Clin Nutr"},{"issue":"2","key":"6572_CR13","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1080\/08037051.2019.1680270","volume":"29","author":"K Joshipura","year":"2020","unstructured":"Joshipura K, Mu\u00f1oz-Torres F, Fern\u00e1ndez-Santiago J, Patel RP, Lopez-Candales A. Over-the-counter mouthwash use, nitric oxide and hypertension risk. Blood Press. 2020;29(2):103\u201312.","journal-title":"Blood Press"},{"key":"6572_CR14","doi-asserted-by":"publisher","first-page":"177702","DOI":"10.1016\/j.ejphar.2025.177702","volume":"999","author":"TP Minari","year":"2025","unstructured":"Minari TP, Pisani LP. Exploring sodium nitrate supplementation in enhancing nitric oxide bioavailability and reducing oxidative stress: implications for blood pressure and endothelial dysfunction in hypertension. Eur J Pharmacol. 2025;999:177702.","journal-title":"Eur J Pharmacol"},{"issue":"6","key":"6572_CR15","doi-asserted-by":"publisher","first-page":"623","DOI":"10.1177\/00220345211064571","volume":"101","author":"E Morou-Berm\u00fadez","year":"2022","unstructured":"Morou-Berm\u00fadez E, Torres-Col\u00f3n JE, Berm\u00fadez NS, Patel RP, Joshipura KJ. Pathways linking oral bacteria, nitric oxide metabolism, and health. J Dent Res. 2022;101(6):623\u201331.","journal-title":"J Dent Res"},{"key":"6572_CR16","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71","author":"MJ Page","year":"2021","unstructured":"Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2021 statement: an updated guideline for reporting systematic reviews. BMJ. 2020. . https:\/\/doi.org\/10.1136\/bmj.n71","journal-title":"BMJ"},{"issue":"17","key":"6572_CR17","doi-asserted-by":"publisher","first-page":"2211","DOI":"10.1002\/1873-3468.14859","volume":"598","author":"B Paiva","year":"2024","unstructured":"Paiva B, Laranjinha J, Rocha BS. Do oral and gut microbiota communicate through redox pathways? A novel asset of the nitrate\u2010nitrite\u2010NO pathway. FEBS Lett. 2024;598(17):2211\u201323. https:\/\/doi.org\/10.1002\/1873-3468.14859.","journal-title":"FEBS Lett"},{"key":"6572_CR18","doi-asserted-by":"publisher","DOI":"10.1161\/jaha.124.035888","author":"SJ Park","year":"2025","unstructured":"Park SJ, Kim M, Jeong S, et al. Antibiotic exposure and cardiovascular disease risk: a nationwide cohort study. J Am Heart Assoc. 2025. https:\/\/doi.org\/10.1161\/jaha.124.035888.","journal-title":"J Am Heart Assoc"},{"key":"6572_CR19","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2019.00039","author":"GD Tribble","year":"2019","unstructured":"Tribble GD, Angelov N, Weltman R, Wang BY, Eswaran SV, Gay IC, et al. Frequency of tongue cleaning impacts the human tongue microbiome composition and enterosalivary circulation of nitrate. Front Cell Infect Microbiol. 2019. https:\/\/doi.org\/10.3389\/fcimb.2019.00039.","journal-title":"Front Cell Infect Microbiol"},{"key":"6572_CR20","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.niox.2016.01.002","volume":"54","author":"M Woessner","year":"2016","unstructured":"Woessner M, Smoliga JM, Tarzia B, Stabler T, Van Bruggen M, Allen JD. A stepwise reduction in plasma and salivary nitrite with increasing strengths of mouthwash following a dietary nitrate load. Nitric Oxide. 2016;54:1\u20137.","journal-title":"Nitric Oxide"}],"container-title":["BMC Cardiovascular Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12872-026-06572-4","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12872-026-06572-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12872-026-06572-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T07:48:30Z","timestamp":1789631310000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12872-026-06572-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,16]]},"references-count":20,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["6572"],"URL":"https:\/\/doi.org\/10.1186\/s12872-026-06572-4","relation":{},"ISSN":["1471-2261"],"issn-type":[{"value":"1471-2261","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,16]]},"assertion":[{"value":"29 September 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"31 August 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 September 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Ethics committee oversight and approval determined to be not applicable, since this review does not involve human subject research, therefore, not requiring institutional review board approval and oversight.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"807"}}